Transitions in a wicked environment

Hudson, Rhett; Comer, Linda; Whichello, Ramona

doi:10.1111/j.1365-2834.2012.1478.x

Cited by 19 publications

(20 citation statements)

References 30 publications

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“…The largest expenditures are for hospital care (about 32%), physician and clinical services (26%), and prescription drugs (10%) ( CMS, 2015 ). With the demographic shifts in the aging population and those with chronic illness, it is anticipated that in three short years, healthcare spending will reach $4.3 trillion ( George & Shocksnider, 2014 , p. 79; Hudson, Comer, & Whichello, 2014 , p. 201).…”

Section: Driving Forces For Change: Cost and Quality Concernsmentioning

confidence: 99%

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Healthcare Transformation and Changing Roles for Nursing

Salmond

Echevarria

2017

Orthopaedic Nursing

238

164

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Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost. Greater coordination of care—across providers and across settings—will improve quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic testing, repeated medical histories, multiple prescriptions, and adverse drug interactions. As a nation, we have taken incremental steps toward achieving better quality and lower costs for decades. Nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare by being a fully contributing member of the interprofessional team as we shift from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an enhanced set of knowledge, skills, and attitudes around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement.

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Section: Driving Forces For Change: Cost and Quality Concernsmentioning

confidence: 99%

“…Healthcare spending is projected to reach $4.3 trillion by 2017 (19.5% of GDP) and $4.6 trillion (19.8% of GDP) by 2020 ( George & Shocksnider, 2014 , p. 79; Hudson et al, 2014 , p. 201).…”

Section: Driving Forces For Change: Cost and Quality Concernsmentioning

confidence: 99%

Healthcare Transformation and Changing Roles for Nursing

Salmond

Echevarria

2017

Orthopaedic Nursing

238

164

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“…Heeding the call to widen scholarly blinkers, health researchers have found value in the wicked problem lens. [21][22][23] Health research suggests two points. First, the wicked problem lens can clarify the complexities that pervade healthcare.…”

Section: Wicked Problemsmentioning

confidence: 99%

“…Heeding the call to widen scholarly blinkers, health researchers have found value in the wicked problem lens . Health research suggests two points.…”

Section: Introductionmentioning

confidence: 99%

Understanding practitioner perspectives of youth healthcare using thematic and lexical analyses

Jarrett

2019

Health Expectations

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BackgroundYouth health issues represent a “wicked problem” – they are complex and multifaceted. Furthermore, they are likely to require novel approaches to understand their complexity and develop novel solutions.ObjectiveGiven the importance of youth healthcare, and the need for novel approaches, the aim of this article was to demonstrate the innovative use of two research methods – thematic and lexical analyses – to better understand practitioner perspectives of youth healthcare. It clarifies the factors that shape practitioner ability to support young people and opportunities to improve practice.Design and SettingFocus groups and interviews were conducted with 37 youth health practitioners. They represented government and non‐government services; hospital and community services; and metropolitan and regional services.ResultsThematic analysis highlighted the complexity of participants' work and the judgements made as they negotiated relationships with young people and ancillary services. Lexical analysis revealed two hitherto neglected dimensions of the complexity of youth healthcare – uncertainty and corporeality.DiscussionIn addition to affirming the complexities of youth healthcare, this study revealed how practitioners (can) negotiate these complexities. These findings were only possible because of the innovative use of the two research methods.ConclusionsThis study has important theoretical, methodological and practical implications. Theoretically, it is the first to view the complexities of youth healthcare through the wicked problem lens. Methodologically, it highlights the complementary value of thematic and lexical analyses. Practically, it reinforces the importance of policy support and professional development to enable practitioners to grasp the complexities of their work.

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“…Many of the reasons for poor transitions of care for older people, including intersectoral conflict, poor handover of information and weaknesses in operational processes, are increasingly well understood. 10 11 In response, academic research and reports have called for leadership, partnership and quality improvement to enable better working between the sectors caring for older people. 4 12 13 However, turning these aspirations into reality has not been straightforward: 14 quality improvement efforts, in this area as in others, do not always deliver the desired success.…”

Section: Introductionmentioning

confidence: 99%

Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people

2016

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ObjectivesQuality improvement projects to address transitions of care across care boundaries are increasingly common but meet with mixed success for reasons that are poorly understood. We aimed to characterise challenges in a project to improve transitions for older people between hospital and care homes.DesignIndependent process evaluation, using ethnographic observations and interviews, of a quality improvement project.Setting and participantsAn English hospital and two residential care homes for older people.Data32 hours of non-participant observations and 12 semistructured interviews with project members, hospital and care home staff.ResultsA hospital-based improvement team sought to reduce unplanned readmissions from residential care homes using interventions including a community-based geriatric team that could be accessed directly by care homes and a communication tool intended to facilitate transfer of information between homes and hospital. Only very modest (if any) impacts of these interventions on readmission rates could be detected. The process evaluation identified multiple challenges in implementing interventions and securing improvement. Many of these arose because of lack of consensus on the nature of the problem and the proper solutions: while the hospital team was keen to reduce readmissions and saw the problems as lying in poor communication and lack of community-based support for care homes, the care home staff had different priorities. Care home staff were unconvinced that the improvement interventions were aligned with their needs or addressed their concerns, resulting in compromised implementation.ConclusionsProcess evaluations have a valuable role in quality improvement. Our study suggests that a key task for quality improvement projects aimed at transitions of care is that of developing a shared view of the problem to be addressed. A more participatory approach could help to surface assumptions, interpretations and interests and could facilitate the coproduction of solutions. This finding is likely to have broader applicability.

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Transitions in a wicked environment

Abstract: Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.

Cited by 19 publications

References 30 publications

Healthcare Transformation and Changing Roles for Nursing

Healthcare Transformation and Changing Roles for Nursing

Understanding practitioner perspectives of youth healthcare using thematic and lexical analyses

Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people

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